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LEARNING GOALS Impact of Critical Illness Importance of Nutrition Goals of nutritional support Nutritional requirements Enteral vs Parenteral When and how to initiate and advance Nutrition Monitoring

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IMMUNE MODULATION MECHANISMS ARE UNCLEAR Reduction of duration and magnitude of inflammatory response Will this disrupt the balance between pro and anti-inflammatory processes?? Of the multiple ingredients in these special formulas: which is “the” one Beneficial effects seen in patients achieving early EN

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CONCLUSIONS Start nutrition early Enteral route is preferred when available Set goals for the individual patient Dose nutrients compatible with existing metabolism Appropriate monitoring is essential Avoid overfeeding

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QUESTION 1 When should nutritional support be initiated in critically ill patients? – Only after extubation – After 3 days of NPO status – After 5 days of NPO status – After 7 days of NPO status – ASAP, preferrably within 24 hours of admission

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QUESTION 2 What would be the preferred mode for nutritional support in a 10 year old boy with head injury, raised ICP and aspiration pneumonia that developed after he vomited during intubation in the field. – Parenteral nutrition – Enteral nutrition – A combination of enteral and parenteral nutrition – IV fluids alone until ICP is better controlled.